Tuesday, February 22, 2011

Former Chicago Bears football star Dave Duerson killed himself recently with a gunshot to the chest. In a suicide note, he wrote: “Please, see that my brain is given to the N.F.L.’s brain bank.” The New York Times reports on the story here. I've blogged about the Boston University Chronic Traumatic Encephalopathy Brain Bank before. Dr. Ann McKee is doing important work there that may shake the very foundation of our national obsession with the game of football.

This guest post, the next in our "Best of the Month" series, is from September 1, 2010 and was authored by Dr. John E. Donahue, neuropathologist at Brown University School of Medicine. Dr. Donahue (pictured) is responding to a question raised by a neurology resident who considering doing a neuropathology fellowship. I would argue that, despite the potential professional hurdles such cross-training might present to the trainee, neurologists who practice neuropathology bring a fresh insight which dynamizes the subspecialty. Here are Dr. Donahue's thoughts :

I am a neurology-trained neuropathologist. Many years ago, that was the norm; almost all neuropathology was done by neurologists. They saw patients, cut brains, looked at slides, and taught. Mass. General Hospital had neurology, neuropathology, and psychiatry as a single department until the late 1950's.

Nowadays, the neurologist-neuropathologist is going the way of the dinosaur, and I may be one of the last of my kind. Neuropathology has been taken over by pathology in most places, and almost all neuropathologists are now pathology-trained. For those that are still in medical school and contemplating neuropathology, as much as it breaks my heart to say this, I'd strongly consider going the pathology route from a pragmatic perspective. In the 21st century, it's much easier to find a job this way. For those that are already in a neurology residency and have their heart set on neuropathology, there are four distinct job possibilities that come to mind. A certain amount of teaching, either to medical students, residents, fellows, or all of the above, is a requirement for most jobs in all of these categories.

1) Neuropathology (NP) only. This is what I thought I was signing up for when I signed up for NP because the neuropathologist where I did my neurology residency did NP only. However, come to find out, these jobs are extremely rare. It would require being in an academic setting with a big enough neurosurgical volume to justify the expense of an NP-only person. This is not a realistic possibility for most jobs.

2) NP/neurology. Very few places have neurology and NP in the same department. The New Jersey Neuroscience Institute in Edison, NJ comes to mind as one. However, in the vast majority of institutions, NP is under the domain of pathology. Thus, in order to pull off the NP/neurology combo, a lot of administrative creativity and flexibility are required. You'd have to be paid by two departments and be beholden to two chairs. Like NP only, this is not a realistic possibility for most jobs.

3) NP with anatomic pathology (AP). In order to be board-certified in NP via the neurology route, in addition to the two-year NP fellowship, you have to do a minimum of one year of an AP residency. If you do a second year, that would make you board-eligible in AP as well. This would significantly increase your marketability and the number of pathology employers that would potentially be interested in hiring you. In the 21st century, if you have your heart set on NP and don't mind examining "lower-organ" pathology, this would be my recommended route to the best job security. Keep in mind that if you go this route, you're looking at EIGHT years of residency and fellowship after medical school graduation (one year internal medicine, three years neurology, two years NP, two years AP). Can you tolerate being a trainee for that long?

4) NP-research. If you have your heart set on neuropathology, hate "lower-organ" pathology, and/or don't want to spend eight years as a clinical trainee, then you most likely will have to go this route. The only way for neuropathologists to generate substantial amounts of revenue without having to do AP is to bring in research grant money, either from NIH, private foundations, industry, or any or all of the above. So you'd best attach yourself to a mentor during your residency and learn how to do basic neuroscience research, generate preliminary data, and submit a grant proposal. With application success rates below 10% nowadays, this option is not for the feint of heart. It really requires a genuine interest in bench research and a willingness to pick yourself up off the canvas and dust off after each rejection until you finally break through. You'll also be doing seven postgraduate years of training after medical school (one internal medicine, three neurology, two NP, one AP).

Tuesday, February 8, 2011

Three London neuropathologists who have called into question the science behind shaken baby syndrome are claiming they have been the victims of a sustained smear campaign perpetrated by the London Metropolitan Police. The BBC reports on the charges here. Drs. Waney Squier, Irene Scheimberg, and Marta Cohen -- who have all been expert witnesses defending caregivers under prosecution for causing a baby's death -- are accusing the London police of trying to undermine their professional credibility.

Wednesday, February 2, 2011

Researchers report in an article in Nature Medicine that a new cerebrospinal fluid test, known as real-time quaking-induced conversion (RT-QUIC) assay, appears to be more specific than the problematic 14-3-3 test, which not infrequently gives false-positive results. ('Quaking-induced' refers to in vitro shaking, which helps to accelerate the reaction.) Not only that: it looks as though RT-QUIC may work on serum samples too, opening up the possibility of much earlier diagnosis and more widespread screening of donated blood. This development could truly revolutionize the pre-mortem diagnosis of prion disease! (Thanks to Dr. Doug Shevlin for calling my attention to this article.)

Tuesday, February 1, 2011

I just got word from the good Dr. Tony Yachnis that there has recently been a big development in Gainesville, Florida. Here's the latest from Dr. Yachnis:

Maria Rivera-Zengotita, MD

Dr. Marie Rivera-Zengotita has joined the Neuropathology Section at the University of Florida College of Medicine as an Assistant Professor of Pathology.She graduated from Ponce School of Medicine in Puerto Rico and completed her residency training in anatomic pathology at the University of Puerto Rico.Dr. Marie Rivera-Zengotita went on to complete a neuropathology fellowship at the Methodist Hospital/Baylor College of Medicine in Houston, Texas.There, she trained in tumor neuropathology at MD Anderson Cancer Center with Dr. Greg Fuller and did general neuropathology with Dr. Susan Z. Powell, who is the current program director and Vice Chair of Education at the Methodist Hospital and, also of note, was the first graduate of the Neuropathology Fellowship Program at the University of Florida!Dr Rivera-Zengotita brings considerable expertise in neuromuscular and ophthalmic pathology in addition to providing outstanding skill in surgical and autopsy neuropathology in support of clinical, research, and teaching missions of the University of Florida College of Medicine.According to Dr. Tony Yachnis (neuropathology program director at UF): "Marie is just what the doctor ordered!"

Best of luck to Dr. Rivera-Zengotita in her new venture! I should also note that this only strengthens the neuropathology fellowship program at the University of Florida, which has a position available starting July 1, 2012. Contact Dr. Yachnis at yachnis@pathology.ufl.edu for more information on that position.